Molina Healthcare Remote Mgr, Health Plan Pharmacy Svcs in Miami, Florida
• Provides oversight and direction to Centralized Pharmacy Utilization Management team
• Acts as liaison to internal and external customers to ensure prompt resolution of identified issues
and serves as the first point of contact for internal departments.
• Assists Director/AVP in the collection and tabulation of data for reporting purposes and maintains
files of confidential information submitted for review.
• Assures that activities and processes are compliant with NCQA guidelines and Molina policies and
procedures and promotes best practice measures to ensure consistency.
• Interviews job applicants and provides hiring recommendations to Director/AVP.
• Communicates with practitioners, pharmacists, and drug representatives
• Collaborates with and keeps Director/AVP apprised of operational issues, including staffing
resources, program and system needs, and regulatory changes.
• Develops policies and procedures as needed.
• Participates in Quality Management and Health Education programs including, but not limited to,
NCQA Accreditation, HEDIS, and Disease Management programs company-wide.
• Attends State and Health Plan meetings as directed by Director/AVP
Molina Pharmacy Services/Management staff work to ensure that Molina members have access to all
medically necessary prescription drugs and those drugs are used in a cost-effective, safe manner. These
jobs are responsible for creating, operating, and monitoring Molina Health Plan’s pharmacy benefit
programs in accordance with all federal and state laws. Jobs in this family include those involved in
formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider
utilization patterns and pharmacy costs management), clinical pharmacy services (such as, therapeutic
drug monitoring, drug regimen review, patient education, and medical staff interaction), and oversight
(establishing and measuring performance metrics with regard to patient outcomes, medications safety
and medication use policies).
• Doctor of Pharmacy from an accredited pharmacy school or Bachelor's Degree in Pharmacy with
• Continuing education required to maintain an active pharmacist license.
• Minimum 5 years experience as a Pharmacist, including at least 3 years in health care delivery.
• 2+ years of leadership experience
• Experience designing, implementing, monitoring and evaluating projects.
• Working knowledge of medical/pharmacy terminology, State and NCQA guidelines
REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:
Active and unrestricted Pharmacist license in good standing.
Must be free of sanctions from Medicaid or any other government program and without restrictions
that would affect job performance.
Graduate Degree or equivalent combination of education and experience
• 7-9 years in the healthcare industry, managed care organization or equivalent experience.
• Knowledge of or experience with decision analysis and data analysis tools, such as SQL, MS Access,
PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:
Working environment is generally favorable and lighting and temperature are adequate. Work is
generally performed in an office environment or remotely in which there is only minimal exposure to
unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods.
Reasonable accommodations may be made to enable individuals with disabilities to perform the
- Molina Healthcare Jobs